Dataset Information

Feasibility and Effectiveness of Continuing Methadone Maintenance Treatment During Incarceration Compared With Forced Withdrawal.

ABSTRACT: BACKGROUND:Methadone maintenance treatment (MMT) is underutilized in correctional settings, and those receiving MMT in the community often undergo withdrawal upon incarceration. Federal and state regulations present barriers to providing methadone in correctional facilities. For this investigation, a community provider administered methadone to inmates who had been receiving methadone prior to incarceration. We hypothesized that inmates continued on MMT would have improved behavior during incarceration and post-release. METHODS:This open-label quasi-experimental trial (n?=?382) compared MMT continuation throughout incarceration (n?=?184) to an administrative control group (ie, forced withdrawal; n?=?198) on disciplinary tickets and other program attendance during incarceration. Post-release, re-engagement in community-based MMT and 6-month recidivism outcomes were evaluated. RESULTS:Inmates in the MMT continuation group versus controls were less likely to receive disciplinary tickets (odds ratio [OR]?=?0.32) but no more likely to attend other programs while incarcerated. MMT continuation increased engagement with a community MMT provider within 1 day of release (OR ?=?32.04), and 40.6% of MMT participants re-engaged within the first 30 days (vs 10.1% of controls). Overall, re-engagement in MMT was not associated with recidivism. However, among a subset of inmates who received MMT post-incarceration from the jail MMT provider (n?=?69), re-engagement with that provider was associated with reduced risk of arrest, new charges, and re-incarceration compared with those who did not re-engage. CONCLUSIONS:Results support interventions that facilitate continuity of MMT during and after incarceration. Engagement of a community provider is feasible and can improve access to methadone in correctional facilities.

SUBMITTER: Moore KE

PROVIDER: S-EPMC6292727 | biostudies-literature | 2018 Mar/Apr

REPOSITORIES: biostudies-literature

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Feasibility and Effectiveness of Continuing Methadone Maintenance Treatment During Incarceration Compared With Forced Withdrawal.

Moore Kelly E KE Oberleitner Lindsay L Smith Kathryn M Z KMZ Maurer Kathleen K McKee Sherry A SA

Journal of addiction medicine 20180301 2

<h4>Background</h4>Methadone maintenance treatment (MMT) is underutilized in correctional settings, and those receiving MMT in the community often undergo withdrawal upon incarceration. Federal and state regulations present barriers to providing methadone in correctional facilities. For this investigation, a community provider administered methadone to inmates who had been receiving methadone prior to incarceration. We hypothesized that inmates continued on MMT would have improved behavior durin ...[more]

PMID: 29341974

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Project description:Background and aimsPharmacy administration and dispensing of methadone for methadone maintenance treatment (MMT) can expand treatment access for opioid use disorder (OUD). This study investigated the feasibility and acceptability of a novel model permitting an opioid treatment program (OTP) physician to prescribe methadone for OUD treatment through collaboration with a partnered pharmacy.DesignNon-randomized, single-arm, open-label feasibility trial.SettingOne OTP and one community pharmacy in the United States.ParticipantsOne OTP physician, two pharmacists and 20 MMT patients receiving between six and 13 take-home methadone doses at 5-160 mg/day.InterventionPatients' methadone administration and dispensing of take-home doses was transferred from the OTP to the pharmacy for 3 months.MeasurementsPrimary outcome was medication adherence. Secondary outcomes were recruitment, treatment retention, substance use, counseling attendance at the OTP, pharmacist prescription drug monitoring program (PDMP) use, safety and satisfaction.FindingsOf 29 patients eligible at pre-screen, 20 patients (69%) enrolled into the study. Recruitment occurred from 6 August 2020 to 10 October 2020. Treatment retention rate at month 3 was 80% (16 of 20). Two participants returned early to the OTP because of a work/schedule change, one due to pregnancy and one following a non-study-related hospitalization. Medication adherence among 16 patients who were retained was 100%. Intervention fidelity was 100%. All participants attended random call-back visits. None showed evidence of tampering/diversion of methadone. Pharmacists checked the PDMP at all visits. All participants attended psychosocial counseling as planned. There were no positive urine screens for illicit opioid use and no study-related adverse events. All participants endorsed 'pharmacy is the right location for receiving methadone for MMT', 88% endorsed 'convenient or very convenient to receive methadone at the pharmacy' and 88% were satisfied or very satisfied with the quality of treatment offered.ConclusionsThis feasibility trial has found pharmacy administration and dispensing of physician-prescribed methadone for methadone maintenance treatment to be feasible and acceptable.

Project description:Opioid analgesic use and disorders have dramatically increased among the general American population and those receiving methadone maintenance treatment (MMT). Most research among MMT patients focuses on opioid analgesics misuse or disorders; few studies focus on MMT patients prescribed opioid analgesics. We describe demographic, clinical, and substance use characteristics of MMT patients prescribed opioid analgesics and compare them with MMT patients not prescribed opioid analgesics.We conducted a cross-sectional secondary data analysis using screening interviews from a parent study. From 2012 to 2015, we recruited adults from 3 MMT Bronx clinics. Questionnaire data included patterns of opioid analgesic use, substance use, comorbid illnesses, and demographic characteristics. Our main dependent variable was patients' report of currently taking prescribed opioid analgesics. To compare characteristics between MMT patients prescribed and not prescribed opioid analgesics, we conducted chi-square tests, t tests, and Mann-Whitney U tests.Of 611 MMT patients, most reported chronic pain (62.0%), hepatitis C virus (HCV) infection (52.1%), and current use of illicit substances (64.2%). Of the 29.8% who reported currently taking prescribed opioid analgesics, most misused their opioid analgesics (57.5%). Patients prescribed (versus not prescribed) opioid analgesics were more likely to report human immunodeficiency virus (HIV) infection (adjusted odds ratio [aOR] = 1.6, 95% confidence interval [CI]: 1.1-2.3) and chronic pain (aOR = 7.6, 95% CI: 4.6-12.6).Among MMT patients primarily in 3 Bronx clinics, nearly one third reported taking prescribed opioid analgesics. Compared with patients not prescribed opioid analgesics, those prescribed opioid analgesics were more likely to report chronic pain and HIV infection. However, between these patients, there was no difference in illicit substance use. These findings highlight the complexity of addressing chronic pain in MMT patients.

Dataset Information

Feasibility and Effectiveness of Continuing Methadone Maintenance Treatment During Incarceration Compared With Forced Withdrawal.

Publications

Feasibility and Effectiveness of Continuing Methadone Maintenance Treatment During Incarceration Compared With Forced Withdrawal.

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